HomeMy WebLinkAbout2148 De~laratior~ of Dorri~cile and Citizenship ~
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TO THE STATE AND COUNTY TAX ASSES~OR,
Sl. IUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapte~ 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of _ ~1~111a 1 d ~h1~1____ _
(City) (State)
and I resided at _ Rt 2 Bpx - _ . However I have changed my domiGile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since day of
-IIecember - .~9_ 64, and I reside a~ 1808 North 49th street
_ -
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal rzsidence and domicile in ihe State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicife, purchasz of home, etc.)
~pplying ior homestead
~ FILE AND RECpRDED ~;~,`y; ' .
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: ,es FFa i ~ Pfq 3 : 2 y _ ~ 1 ~ _
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ROGFh ;'~~~i;;: ~LERK ~ ~
ST. LUCIE CGUNTY, - _ ~ ` ' . i
. FLORIDA - ~ ~ " .
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I FURTHER CERTIFY that I will comply with all other requiremenis of a legal resident of this State.
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~ 1 FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT ~
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F PIERGE, SA~~j, LUCIE COUNTY, FLORIDA, permanently. ~
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i ` ~:i~~.~~ _ • _ (Name) }
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Swom to and subscribed before me this 14th day of - ~'~he_ , 19~__.
ROGER POITRAS
LERK CIRCUIT CQURT Notary Public
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By D.C. My Commission expires
(To be executed in duplicate and originat filed with Clerk Circuit CouH, and duplicata with Tax Assassor.)
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